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General NPI Number Information
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NPI Number | 1063890861
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Entity Type | Organization
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Legal Business Name | KING MOXA ACU CLINIC INC.
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 7235 ORANGETHORPE AVE
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City | BUENA PARK
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State | CA
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Zip | 90621-3311
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Country | US
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Telephone | 714-735-9666
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Fax | 714-266-0637
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Provider Business Mailing Address
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Address Line | 7235 ORANGETHORPE AVE
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City | BUENA PARK
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State | CA
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Zip | 90621-3311
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Country | US
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Telephone | 714-735-9666
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Fax | 714-266-0637
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAE IL WON
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Credential | L.AC.
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Telephone | 714-735-9666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | CA15920
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License Number State | CA
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